ICD-10 Compliance: An Opportunity to Improve Revenue Cycles?

Brien Posey, Freelance Writer and Former CIO | 3/4/2014 | 5 comments

Brien Posey
Right now there seems to be a mild sense of anxiety among healthcare providers regarding the impending deadline to make the transition to ICD-10 coding. Not only are there operational logistics to consider, but many providers also expect the transition to affect their revenue cycles.

The reason for the expected impact has to do with the way that claims are sent to payers. To put it simply, healthcare providers must submit billing information to payers using a format that they both understand and accept. Unless a provider takes the time to discuss general equivalency mappings and diagnosis-related groups with payers, they risk submitting billing data in a way that results in a denial or a suspension of claims. As such, many facilities are concerned that their revenue cycles will be negatively affected after the Oct. 1 deadline, simply because claims that would have normally been paid are now being denied.

In spite of the negative predictions pertaining to the ICD-10 deadline, there may be ways in which providers can actually use the transition to ICD-10 to improve their revenue cycles.

One of the first things that providers should do is to have a have a heart-to-heart conversation with employees who actually perform the coding. It is entirely possible that staff members might not understand the importance of their job and just how dramatically the codes that they enter can affect the organizationís accounts receivable. It may even be possible for providers to provide staff members with some sort of incentive to help them strive to achieve 100% accurate coding.

Since coding accuracy can have such a dramatic effect on accounts receivable, it makes sense to do what you can to eliminate careless errors. While taking measures to encourage the staff to enter codes accurately might help, it will only get you so far. As such, it is a good idea to eliminate the possibility of human error wherever you can.

One of the best ways to accomplish this is to take an exhaustive look at the organizationís workflows with regard to coding. The goal in doing so should be to determine how and when ICD codes are being captured and to look for ways to use technology to automate code generation and integrate the solution with your EHR system.

Itís also a good idea to audit processes that are already automated. For example, if scanning a barcode results in the creation of an ICD code, you should verify that the expected code is being generated.

For the time being, some coding will continue to be done manually. The only way that staff members will be able to perform the coding process accurately is if they have had the proper training. Rather than providing staff members with generalized ICD-10 training, however, you might consider using a two-tier approach to the training process.

The first tier would consist of generalized ICD-10 training. This is where staff members learn the basics of working with ICD-10 codes. The second tier of training would consist of training that is more focused on the organizationís specific practices. For example, a cardiologist office is going to use a lot of codes that are related to cardiology, whereas they might not ever use a code associated with podiatry. As such, it would make sense to make sure that the staff is well-versed in codes that are specific to cardiology.

It may very well be possible to use coding automation and other measures to improve accuracy, thereby decreasing claims denials. It is extremely important to test your ICD-10 coding techniques before the conversion deadline. Most major payers will allow providers to submit test claims in an effort to see if the payer would have handled the claim in the manner that the provider expected. This type of testing is essential to ensuring a smooth transition to ICD-10.

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tekedge   ICD-10 Compliance: An Opportunity to Improve Revenue Cycles?   3/15/2014 5:08:07 PM
ICD 10 Compliance
@Brian I loved the idea of a 2 tier training one overall and one department specific ! It will really help the employees and get the job done!
tekedge   ICD-10 Compliance: An Opportunity to Improve Revenue Cycles?   3/15/2014 4:13:01 PM
ICD 10 Complaince: An Opporunity to improve Revenue Cycles
Yeah the change is causing a really dramatic effect in our field . It is worrisome and there is anxiety of losing money, but like all changes it will settle down as time goes by. Till then we all have to take it one change at a time and hope we do not end up harried and harassed ! 
neotoren   ICD-10 Compliance: An Opportunity to Improve Revenue Cycles?   3/7/2014 4:14:54 PM
Re: Love ICD-10...
Anticipating the huge ICD-10 impact on October 1st, we have recently release a unique app you may test at http://icd10doc.com

Let us know your feedback 


zerox203   ICD-10 Compliance: An Opportunity to Improve Revenue Cycles?   3/5/2014 1:00:10 AM
Re: ICD-10 Compliance
Thanks for this, Brien. I personally do not work in healthcare, but for that very reason, it's all that more useful to me to get some insight from someone who does. Whether you're a CIO in an unrelated field, or just layperson who could care less about technology, all these recent healthcare developments and changes are something that affect you directly. I find the on-the-floor insights that people share in the comments to these articles especially helpful - nothing to me is as valuable as real opinions from real people with no dog in the fight (other than doing their jobs right).

Forgive my ignorance on ICD-10 specifically, but I can get the gist of what it means from the context here and a quick glance at the cms.gov page you linked. Something about this strangely reminds me of the panic of the Y2K bug - not necessarily in scope, but just in the anxiety it's causing. A minor change that by all accounts ought to be no problem, but a single piece of data in the wrong spot at the wrong time could cost people a lot of money. Even though it IS terrifying, it's a little funny how we build up such complicated and piecemeal systems that they can be easily broken by small changes that we intentionally make, isn't it?
ProgMan   ICD-10 Compliance: An Opportunity to Improve Revenue Cycles?   3/4/2014 10:23:52 AM
Love ICD-10...
I'm in a unique position - by and large ICD-10 has no impact on our product at all.  It's an ancillary piece of data that we collect and we've allocated a field that has a length of 25 characters for it so it expanding means nothing.  Obviously, our software is not at the crux of life and death diagnosis and billing decisions for hospitals so that makes sense.

Still, we are slowly being called upon to make customizations to certain forms and viewing options we have around the displaying of this data, so there is a little extra work involved.  It's a good spot to be in, knowing there are guys out there who are up at nights worrying about their system changes.  I guess when we get around to ICD-26 I'll be one of those guys.    

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